The Practice of Defensive Medicine Among Hospital Doctors in the United Kingdom

Overview

Journal BMC Med Ethics

Publisher Biomed Central

Specialty Medical Ethics

Date 2013 Oct 31

PMID 24168064

Citations 37

Authors

Osman Ortashi

Jaspal Virdee

Rudaina Hassan

Tomasz Mutrynowski

Fikri Abu-Zidan

Affiliations

Soon will be listed here.

Abstract

Background: Defensive medicine is defined as a doctor's deviation from standard practice to reduce or prevent complaints or criticism. The objectives of this study were to assess the prevalence of the practice of defensive medicine in the UK among hospital doctors and the factors affecting it.

Methods: A quantitative study was designed, with a detailed seventeen point questionnaire. Defensive medicine practice was assessed and tested against four factors age, gender, specialty and grade. Three hundred hospital doctors from three UK hospitals received the questionnaire.

Results: Two hundred and four (68%) out of 300 hospital doctors responded to the survey. Seventy eight percent reported practicing one form or another of defensive medicine. Ordering unnecessary tests is the commonest form of defensive medicine reported by 59% of the respondents. This is followed by unnecessary referral to other specialties (55%). While only 9% of the sampled doctors would refuse to treat high risk patients, double this number would avoid high risks procedures all together (21%). A linear regression module has shown that only senior grade was associated with less practice of defensive medicine.

Conclusion: Defensive medical practice is common among the doctors who responded to the survey. Senior grade is associated with less practice of defensive medicine.

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References

Studdert D, Mello M, Sage W, DesRoches C, Peugh J, Zapert K . Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005; 293(21):2609-17. DOI: 10.1001/jama.293.21.2609. View

Brilla R, Evers S, Deutschlander A, Wartenberg K . Are neurology residents in the United States being taught defensive medicine?. Clin Neurol Neurosurg. 2005; 108(4):374-7. DOI: 10.1016/j.clineuro.2005.05.013. View

Corrigan J, Wagner J, Wolfe L, Klingman D, Polishuk P . Medical malpractice reform and defensive medicine. Cancer Invest. 1996; 14(3):277-84. DOI: 10.3109/07357909609012149. View

Marin P, Bayer A, Tomlinson A, PATHY M . Attitudes of hospital doctors in Wales to use of intravenous fluids and antibiotics in the terminally ill. Postgrad Med J. 1989; 65(767):650-2. PMC: 2429185. DOI: 10.1136/pgmj.65.767.650. View

Summerton N . Trends in negative defensive medicine within general practice. Br J Gen Pract. 2000; 50(456):565-6. PMC: 1313753. View

Kessler D . Evaluating the medical malpractice system and options for reform. J Econ Perspect. 2011; 25(2):93-110. PMC: 3195420. DOI: 10.1257/jep.25.2.93. View

Catino M, Celotti S . The problem of defensive medicine: two Italian surveys. Stud Health Technol Inform. 2009; 148:206-21. View

Dubay L, Kaestner R, Waidmann T . The impact of malpractice fears on cesarean section rates. J Health Econ. 1999; 18(4):491-522. DOI: 10.1016/s0167-6296(99)00004-1. View

Ennis M, Clark A, Grudzinskas J . Change in obstetric practice in response to fear of litigation in the British Isles. Lancet. 1991; 338(8767):616-8. DOI: 10.1016/0140-6736(91)90616-w. View

10.

Toker A, Shvarts S, Perry Z, Doron Y, Reuveni H . Clinical guidelines, defensive medicine, and the physician between the two. Am J Otolaryngol. 2004; 25(4):245-50. DOI: 10.1016/j.amjoto.2004.02.002. View

11.

Hiyama T, Yoshihara M, Tanaka S, Urabe Y, Ikegami Y, Fukuhara T . Defensive medicine practices among gastroenterologists in Japan. World J Gastroenterol. 2006; 12(47):7671-5. PMC: 4088051. DOI: 10.3748/wjg.v12.i47.7671. View

12.

Miller R, Sampson N, Flynn J . The prevalence of defensive orthopaedic imaging: a prospective practice audit in Pennsylvania. J Bone Joint Surg Am. 2012; 94(3):e18. DOI: 10.2106/JBJS.K.00646. View

13.

Elli L, Tenca A, Soncini M, Spinzi G, Buscarini E, Conte D . Defensive medicine practices among gastroenterologists in Lombardy: between lawsuits and the economic crisis. Dig Liver Dis. 2013; 45(6):469-73. DOI: 10.1016/j.dld.2013.01.004. View

14.

Dyer C . NHS compensation fund gets 185m pound bailout as claims rise by 30% in a year. BMJ. 2012; 344:e411. DOI: 10.1136/bmj.e411. View

15.

Summerton N . Positive and negative factors in defensive medicine: a questionnaire study of general practitioners. BMJ. 1995; 310(6971):27-9. PMC: 2548439. DOI: 10.1136/bmj.310.6971.27. View

16.

Chen X . Defensive medicine or economically motivated corruption? A confucian reflection on physician care in China today. J Med Philos. 2007; 32(6):635-48. DOI: 10.1080/03605310701681021. View

17.

Thorpe K . The medical malpractice 'crisis': recent trends and the impact of state tort reforms. Health Aff (Millwood). 2004; Suppl Web Exclusives:W4-20-30. DOI: 10.1377/hlthaff.w4.20. View

18.

Nguyen Thi P, Briancon S, Empereur F, Guillemin F . Factors determining inpatient satisfaction with care. Soc Sci Med. 2002; 54(4):493-504. DOI: 10.1016/s0277-9536(01)00045-4. View

19.

Rodriguez R, Anglin D, Hankin A, Hayden S, Phelps M, McCollough L . A longitudinal study of emergency medicine residents' malpractice fear and defensive medicine. Acad Emerg Med. 2007; 14(6):569-73. DOI: 10.1197/j.aem.2007.01.020. View

20.

Sethi M, Obremskey W, Natividad H, Mir H, Jahangir A . Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. Am J Orthop (Belle Mead NJ). 2012; 41(2):69-73. View